Hormones and sexuality: current complexities and future directions

Complex correlations between women's sexual function and psychosexual variables confound the identification of any etiological role for estrogen and androgen deficiencies in sexual dysfunction. Although serum levels of androgens show minimal correlation with women's sexual function, the intracellular production of testosterone from adrenal and ovarian precursors may be relevant. Current research involves the detailed assessment of mid aged and older women, with and without sexual dysfunction, assessing medical and multiple psychosexual parameters, estrogen status, serum testosterone levels by mass spectrometry methods plus total androgen activity by means of androgen metabolites. Identification of any correlation between androgen activity and sexual function is one priority. A second is to confirm safety and efficacy of supplemental systemic estrogen and androgen from early menopause in sexually symptomatic women. Although local estrogen supplementation is effective therapy for loss of genital sexual sensitivity and vaginal elasticity, and reduced potential for lubrication, any systemic testosterone therapy requires concomitant systemic estrogen therapy. In the future, augmentation of estrogen and androgen sexual effects may be possible using certain selective estrogen and androgen receptor modulators.